AHIP AHIP Certification AHM-250 Questions & Answers

• Question 21:

  Integration of provider organizations is said to occur when A. Previously separate providers combine and come under common ownership or control.

  B. Two or more providers combine their business operations that they previously carried out separately.

  C. Both A and B

  D. None of the above

  Correct Answer: C

• Question 22:

  When the Knoll Company purchased group health coverage from the Castle Health Maintenance Organization (HMO), the agreement between the two parties specified that the plan would be a typical fully funded plan. Because Knoll had been covered under a previous

  A. 230

  B. 270

  C. 220

  D. 180

  Correct Answer: C

• Question 23:

  The statements below describe technology used by two health plans to respond to incoming telephone calls:

  The Manor Health Plan uses an automated system that answers telephone calls with recorded or synthesized speech and prompts the caller to respond t

  A. Manor's system is best described as an automated call distributor (ACD).

  B. Both Manor's system and Squire's device are applications of computer/telephone integration (CTI).

  C. Squire's device is best described as an interactive voice response (IVR) system.

  D. All of these statements are correct.

  Correct Answer: B

• Question 24:

  Calculate the hospital bed days per 1000 members for the Month to date (MTD) on 25 April, with plan membership of 25,000 and total gross hospital bed days in MTD is 300 for an XYZ Health plan?

  A. 175

  B. 480

  C. 1000

  D. 365

  Correct Answer: A

• Question 25:

  The following statements apply to health reimbursement arrangements. Select the answer choice that contains the correct statement.

  A. Only employers are permitted to establish and fund HRAs.

  B. The popularity of HRAs waned following a 2002 ruling by U.S. Treasury Department regarding their treatment in the tax code.

  C. HRAs must be offered in conjunction with a high-deductible health plan.

  D. The guaranteed portability feature of HRAs has contributed to their popularity.

  Correct Answer: A

• Question 26:

  The following statements are about the make-up and function of an HMO's board of directors. Select the answer choice that contains the correct statement.

  A. The make-up of an HMO's board of directors is prescribed by state regulations and does not vary according to whether the plan is a for-profit or not-for-profit plan.

  B. The board of directors of a not-for-profit HMO is exempt from liability for its actions.

  C. An HMO's board of directors is not responsible for supervising the performance of its officers and outside advisors.

  D. A primary function of the board of directors is to approve and evaluate the organization's operational policies and procedures.

  Correct Answer: D

• Question 27:

  The following statement(s) can correctly be made about the Joint Commission on Accreditation of Healthcare Organizations (JCAHO):

  A. JCAHO's accreditation process for MCOs and healthcare networks consists of complete on-site surveys conducted every three

  B. A only

  C. Neither A nor B

  D. Both A and B

  E. B only

  Correct Answer: A

• Question 28:

  When determining physicians' fee reimbursements, the Blossom Managed Healthcare Group assigns a weighted value to each medical procedure or service and multiplies the weighted value by a money multiplier, as shown below:

  A. discounted fee-for-service system

  B. global capitation arrangement

  C. withhold arrangement

  D. relative value scale (RVS)

  Correct Answer: D

• Question 29:

  Combined system of preventive, diagnostic and therapeutic measures that focuses on management of specific chronic illness or medical conditions are:

  A. Utilization Review

  B. Case Management

  C. Demand Management

  D. Disease management

  Correct Answer: B

• Question 30:

  When the Knoll Company purchased group health coverage from the Castle Health Maintenance Organization (HMO), the agreement between the two parties specified that the plan would be a typical fully funded plan. Because Knoll had been covered under a previous

  A. Castle is responsible for paying for all incurred covered benefits

  B. Knoll is solely responsible for guaranteeing claim payments

  C. Knoll makes no premium payments to Castle

  D. Castle has no responsibilities for administering the health plan

  Correct Answer: A